RT Book, Section
A1 Hillman, Robert S.
A1 Ault, Kenneth A.
A1 Leporrier, Michel
A1 Rinder, Henry M.
SR Print(0)
ID 1127765912
T1 MACROCYTIC ANEMIAS
T2 Hematology in Clinical Practice, 5e
YR 2016
FD 2016
PB McGraw-Hill Medical
PP New York, NY
SN 9780071626996
LK accessbiomedicalscience.mhmedical.com/content.aspx?aid=1127765912
RD 2024/04/19
AB CASE  HISTORY  •  Part  1A  42-year-old  male  presents  to  the  emergency  room  confused  and  combative  with  alcohol  on  his  breath.  He  has  a  history  of  chronic  alcoholism,  alcoholic  liver  disease,  and  dementia.  He  had  been  "dry"  for  almost  a  year  before  resuming  drinking  a  month  ago.  On  examination  he  has  normal  vital  signs,  a  sallow  complexion,  and  multiple  bruises  over  both  shins  and  forearms.  Liver  and  spleen  are  both  palpable.  Neurological  examination  is  notable  for  stocking  glove  anesthesia  and  poor  position  sense.  Routine  labs  are  ordered:CBC:  Hematocrit/hemoglobin  -  29%/9  g/dLMCV  -  107  fL  MCH  -  34  pg  MCHC  -  32  g/dLRDW-CV  -  15%RDW-SD  -  55  fLReticulocyte  count/index  -1.5%/<1White  cell  count  -  5,300/μLPlatelet  count  -  65,000/μLBLOOD  SMEAR  MORPHOLOGYMixed  population  of  normocytic  and  macrocytic  red  cells  with  moderate  aniso-  and  poikilocytosis,  polychromasia,  and  the  occasional  target  cell.A  bone  marrow  aspirate  is  also  obtained  and  on  preliminary  reading  shows  a  relatively  hypercellular  marrow  with  a  ratio  of  erythroid  to  granulocytic  precursors  (E/G  ratio)  of  1:1,  megaloblastic  maturation  of  both  the  erythroid  and  granulocyte  progenitors,  and  normal  megakaryocyte  numbers.QuestionsHow  should  this  anemia  be  described?What  is  the  differential  diagnosis?What  additional  tests  are  in  order?